Which treatment for early bowel cancer

Doctors look at a number of factors when they are planning your treatment

• The type and size of the cancer
• Your general health
• Your age
• Whether the cancer has spread (the stage)
• What the cancer cells look like under the microscope (the grade)

You may find that other people you meet are having different treatment from you. This may be because some of the factors above are different. You can ask your doctor or nurse any questions you have about your treatment.

It often helps to write down a list of questions you want to ask. You could also take a close friend or relative with you when you go to see the doctor so that they can help you remember what was said.

In many people with early bowel cancer the surgeon can take out all of the cancer during an operation. Some people who have this treatment will be cured. This means that their cancer never comes back.

Whether your surgeon can try to cure your cancer by removing it all depends on

• The size of the cancer
• Whether the cancer has spread (the stage)
• Your general health

Unfortunately, not everyone who has surgery will be cured. The cancer may come back in the bowel some time later. If the cancer had spread into the lymph nodes close to the bowel, it is possible that some cells had already travelled to other parts of the body before you had your surgery. These cells may begin to grow into secondary cancers (metastases) in the future. To try to prevent this, your specialist may suggest further treatment after your surgery.

Doctors don't often use radiotherapy to treat cancer of the large bowel (colon). But you may have it either before or after surgery if you have cancer of the back passage (rectal cancer).

Sometimes doctors give radiotherapy and chemotherapy together for rectal cancer. If you have a large tumour, chemotherapy and radiotherapy before surgery may shrink the cancer and make it possible to completely remove it. Or it may mean that you do not need such a big operation. Radiotherapy  after surgery can lower the chance of the cancer coming back for some people.

Your specialist may suggest chemotherapy to try to kill any cancer cells left behind after your operation. This is called adjuvant chemotherapy. The surgeon removes all the cancer they can see. But sometimes cells are left behind because they have spread into the surrounding tissue or to nearby lymph nodes. You can have chemotherapy after surgery for tumours anywhere in the bowel or rectum. Several clinical trials in the UK are comparing different types of chemotherapy after surgery to see which works best. 

People with very early stage bowel cancer (Dukes' A) do not need chemotherapy after surgery.

If you have a Dukes' B cancer, your specialist may suggest chemotherapy after surgery, possibly as part of a clinical trial. Doctors are still not sure whether chemotherapy after surgery lowers the risk of the cancer coming back in bowel cancers of this stage. Some people with Dukes' B may be at a higher risk of their cancer coming back, for example if cancer cells are found in blood or lymph vessels around the tumour. In this case your doctor may discuss the option of chemotherapy with you. The National Institute for Health and Clinical Excellence (NICE) says that you and your cancer specialist should discuss whether or not to have chemotherapy after surgery if you have a Dukes' B bowel cancer.

Most people with Dukes' C bowel cancer will have chemotherapy after surgery. Fluorouracil is commonly used. You may have this through a drip into a vein or as a tablet (capecitabine or uftoral). You may have another cancer drug with fluoruracil, such as oxaliplatin. Your doctor may suggest a clinical trial to you. Researchers are testing several different drugs and drug combinations to try to find which ones are the best at stopping bowel cancer from coming back.

Doctors are researching other ways of trying to shrink a cancer before surgery and of trying to stop cancer from coming back. Some clinical trials are using biological therapies called monoclonal antibodies before or after surgery. You can find more information about this on the bowel cancer research page.

Our clinical trials database has information about bowel cancer trials in the UK. To get there, follow the link and choose 'bowel' from the dropdown menu of cancer types.

After your treatment has finished, you will have regular check ups for several years. At first they will be every few months. But if all is well the appointments will gradually become less and less frequent. You can read more about this and tests you may have on the follow up appointments page.

Some people feel they would like to get an opinion from a second doctor before they decide about their treatment. If you would like a second opinion, you can ask your specialist or your GP. It can be better to arrange a second opinion through your specialist because then all your notes and test results can be sent with you.

Some organisations can give information about the choices of treatment available. Or they can put you in touch with cancer support groups where you can talk to other people who have been through similar experiences to your own.